Will Arkansas need jaws of life?

If you think conflict and high stakes are more interesting than smoothly functioning day-to-day government, and you probably do, then this next month at the State Capitol is for you.

At issue is whether 267,590 Arkansans will remain eligible for government-provided health insurance. That’s the number that had been approved for coverage under the private option as of the end of January.

Here’s the background. The private option was created in 2013 after the U.S. Supreme Court ruled states could choose, rather than be required, to expand Medicaid under Obamacare. (Medicaid is the government health care program that serves the poor, the aged and the disabled.) If states so chose, benefits would go to adults with incomes up to 138 percent of the federal poverty level, which is an $11,880 salary in a household of one and is higher for larger families.

Many Republican-led states then refused the Medicaid money. Arkansas instead used it to purchase private insurance for that population. It’s the reason the state has reduced its uninsured population by one of the highest percentages in the nation, and it’s projected to save Arkansas hospitals a billion dollars’ worth of unreimbursed care over the next five years. But opponents say it’s an unaffordable expansion of Obamacare that creates more government dependency and increases the national debt.

Last week, legislators were called into special session by Gov. Asa Hutchinson to vote on his version of the private option, which he is calling Arkansas Works. He’s pushing it hard. It passed in the House, 70-30, and in the Senate, 25-10. Majorities of Republicans and Democrats in both chambers supported it.

But even those comfortable margins were not big enough to assure the program will continue. The Legislature now moves into a fiscal session, where funding for state agencies requires a three-fourths majority in both Houses – 75 in the House and 27 in the Senate.

Traditionally, legislators have not used the funding process to overturn what was decided in the lawmaking process. If they lose the battle over the policy, they don’t try to block funding.

But opponents are promising to fight this thing to the death in the fiscal session, even if it means, as a tactic, voting against funding the entire Department of Human Services’ Medical Services Division. That division administers not only the private option, but many other medical services, such as nursing home care and health services for foster kids.

The House of Representatives seems more likely to avoid such a fight. Rep. Laurie Rushing, R-Hot Springs, who was one of the 30 who voted no, the next day voted only “present” in a largely procedural vote and then attended the bill signing. She told the Arkansas Democrat-Gazette she and six other House members won’t fight the funding. That’s enough to assure passage.

But the Senate – that’s where it’s going to be interesting. It takes only nine senators out of 35 to block funding, and nine of the 10 opponents have made it clear they will not budge. The 10th, Sen. Missy Irvin, R-Mountain View, is declining to comment about the issue at the moment.

Meanwhile, many Arkansas Works supporters in the Senate are also resolute. If nine opponents can block any DHS funding bill with Arkansas Works, then nine supporters can block any funding bill without it.

All 11 Senate Democrats voted for Arkansas Works. They typically don’t play hardball, but this time? Here’s what Sen. Bruce Maloch, D-Magnolia, said Tuesday: “I don’t think we’re going to pick out a specific agency or entity or college in any of the 10 districts of the senators that voted against it and try to kill their appropriation. … But we will not vote for a DHS Medical Services appropriation without Arkansas Works.”

Sen. Bart Hester, R-Cave Springs, one of the most outspoken opponents, was quoted by the Arkansas Democrat-Gazette observing that both sides are playing chicken, both have a foot on the accelerator, and a “crash” appears inevitable.

In signing the unfunded bill into law, Hutchinson said he hopes that’s not the case. He said he won’t horse trade but that he has “a lot of tools in my pocket.”

The 19 states that haven’t expanded Medicaid are under Republican control in the governor’s mansion and/or the legislature. What these people have in common is an absolutely visceral hate for President Obama. They have decided to follow Mitch McConnell’s example and not cooperate with Obama in any way. When Obama didn’t become a one-term president as McConnell wanted, these people dug in their heels even further. The sad thing is that these 19 states are in terrible financial condition because they will not receive money from something that’s connected to Obama. This is a classical example of cutting off your nose to spite your face. Their nose is missing and blood is streaming down their bodies, but under no condition will they do the prudent thing. They care more about their hate and their political principles than they do the welfare of their citizens. A great example is Oklahoma, where the governor and legislature have a visceral hate for Obama that’s way, way off the charts. That state is standing in a $1.3 billion budget hole. It will never, never under any circumstances put the welfare of the citizens ahead of partisan politics. Oklahoma is now virtually dismantleing Medicaid and kicking over 111,000 children and single mothers off the rolls. It is reducing payments for Medicaid services to the point that providers will literally lose money by treating patients. Most of the nursing homes and many hospitals are in danger of closing. The cuts to public schools are so extreme that public schools in Oklahoma as we have known them will be no more. On and on it goes. All of this, the Republicans think, is preferable to acccepting one penny from the Affordable Care Act!
Of course, we all know what’s behind this hatred for President Obama, don’t we? Don’t we?

These Republicans extremists are doing great harm to the concept of federalism. Allowing states to be laboratories for ideas is great…except when so many of the Republican-led states refuse to implement any ideas.

Hi, Sandy. I’m sorry I’m just now responding to your comments. I think that clearly the visceral dislike of President Obama is a part of these decisions states are making, and obviously part of the dislike is based on racism.

But how much, I don’t know. I try to be very careful about assigning terrible motives to any one person. I don’t know what’s in the hearts of the 10 legislators who oppose the expansion, but I choose to assume that they oppose Arkansas Works for legitimate reasons until I have proof otherwise. I think most legislators, including the 10, are good people, and so I think it’s best just to debate these things on the merits.

So on the merits, I think that getting rid of the private option would be a bad idea, for all the reasons you stated.

Hi, Ken. I agree that the GOP is in danger of defining itself as the party of no. You can’t define yourself by what you are against. You have to be for something. And you have to address problems. Repeal and replace Obamacare? OK. Replace it with what?

I just don’t know Steve. Paul Harrell said 40% of Arkansas was on Medicaid, where he got that figure I don’t know. You stated previously that program was costing Arkansas
in federal dollars $1.63 billion and that next year Arkansas would be liable for 5% and in 2020, 10% where will we get those $$.

Can we leave 267,000 people in Arkansas without insurance, can we afford to let hospitals swallow the tab for unpaid medical expenses if Arkansas Works fails to be funded??
Obamacare is a noble idea but can this nation, this state afford it while the nation is $15 trillion in debt and our state is presently stable. What do you do??

Seems anti-tax republicans need to put additional taxes on alcohol, soft drinks, candy bars or food in general to raise the $$ to pay for this since Arkansas is the MOST OBESE STATE IN THE NATION which was recently pronounced. Tax us where all this fat is coming from!!

Yep. Tough questions all around. Here’s another stat. Arkansas Works will bring $9 billion into the state’s health care economy over five years. Meanwhile, other aspects of the Affordable Care Act will cost the state’s health care economy $5 billion. So if Arkansas says no, it loses that $5 billion.

I was not aware of these dollar figures you stated. If the state could find a way to corner that $5 billion and earmark it to pay for future Arkansas expenses then that would be a good use of this expected income.

The only problem with state income taxes is it will go into the general fund and could not be ear marked for use in certain expenses. If Obesity is the number one problem in Arkansans’ health then tax us where we spend our money–sugar and carbohydrates- in general—food—-that way everyone pays. Should we tax the upper class for health problems of the middle and lower class? I am not rich but if some foods cost more and make me fat I will “get the drift”, and probably quit buying so much of that stuff and eat healthier.

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Meet the author …

Steve Brawner is a freelance journalist. His syndicated columns appear in nine Arkansas newspapers, and he is a frequent contributor to Talk Business & Politics. He appears regularly on the AETN public affairs television show, “Arkansas Week.”

To syndicate his column or hire him to write or speak, email him at brawnersteve@mac.com. Follow him on Twitter at @stevebrawner.

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